老年慢性病患者用药依从性现状及对策研究

目的:研究老年慢性病患者用药依从性现状及对策。方法 :选择2018年11月-2019年11月社区卫生中心调查的老年慢性病患者160例,对患者的用药依从性现状进行调查,并分析影响用药依从性的原因,提出解决对策。结果 :所选160例老年慢性病患者中,用药依从性好60例(37.50%),用药依从性差100例(62.50%)。单因素分析显示,影响老年患者用药依从性原因为文化程度、家庭收入、居住情况、疾病认知(P 0.05)。多因素分析显示,文化程度低、家庭收入低、独自居住、疾病认知欠缺是影响老年慢性病患者用药依从性的独立危险因素(P 0.05)。结论 :当前老年慢性病患者用药依从性情况不容乐观,影响因素较多,社区卫生中心要采取积极措施加以干预,提升用药依从性,促进疾病防治效果的提升。     

长期口服糖皮质激素对慢性病患儿情绪心理状态的影响

目的 分析长期口服糖皮质激素对慢性病患儿情绪心理状态的影响。方法 采用便利抽样方法,选取口服糖皮质激素类药物3个月及以上的10~18岁患儿140例,采用Piers-Harris儿童自我意识量表及儿童抑郁障碍自评量表等进行调查,运用分层回归分析方法探讨长期口服糖皮质激素对患儿情绪心理状态的影响。结果 本研究中138名慢性病患儿自我意识得分为55.50±11.49,29.0%的患儿自我意识水平较低;抑郁障碍自评量表得分为9.11±4.81,15.9%的患儿存在抑郁障碍。分层回归分析结果显示,激素用药状况可分别解释自我意识、抑郁障碍5.6%、3.1%的变异量。结论 长期口服糖皮质激素会影响慢性病患儿的情绪心理状态,易出现自我评价较低、抑郁障碍等负性情绪反应,应予以关注。     

农村慢性病患者用药依从性现状调查分析

目的探讨农村慢性病患者的用药依从性。方法随机抽取4个行政村的慢性病患者发放疾病治疗情况调查表,对其对疾病的认知度和用药依从性进行调查分析。结果通过调查显示,农村慢性病患者医学知识匮乏,对疾病的认知度和用药依从性都较差。结论农村慢性病患者的用药依从性低,已严重影响到慢性病的治疗控制效果,尽快采取有效的措施给予纠正已成为当务之急。     

儿童哮喘缓解期治疗依从性差的调查分析及对策

目的通过分析儿童哮喘缓解期治疗依从性,探讨改善依从性差的对策,从而提高儿童哮喘的治愈水平。方法选择2006年12月～2009年12月期间因哮喘再次发作来院复诊的398例患儿,分析其哮喘规范化治疗依从性及糖皮质激素吸入治疗依从性,明确哮喘复发患儿治疗依从性差的主要原因。结果通过问卷调查发现,复诊患儿中共360例患儿哮喘规范化治疗依从性差,还发现糖皮质激素吸入依从性差患儿未按时来院随访,哮喘相关疾病知识欠缺是规范化治疗依从性差的主要原因。进一步分析糖皮质激素吸人治疗依从性差而复发哮喘的176例患儿,担心药物副作用而停药,没有掌握正确用法和用量认为哮喘痊愈而停药,患儿治疗不配合是导致糖皮质激素吸人治疗依从性差的主要因素。结论治疗依从性差是患儿复发哮喘的重要因素,针对患儿家长开展哮喘知识讲座,指导家长合理用药,定期来院随访是提高患儿哮喘治愈水平的重要手段。     

基本药物制度背景下慢性病患者用药依从性影响因素分析

目的了解基本药物制度背景下慢性病患者用药依从性的影响因素。方法利用Morisky患者用药依从性问卷测量1 200名慢性病患者用药依从性,并对数据进行单因素与多因素分析。结果慢性病患者对基本药物制度知晓率为50.7%(608/1 200);63.8%(765/1 200)的慢性病患者用药依从性表现较好,城市患者用药依从性为64.3%(222/345),好于农村的63.5%(543/855),不发达地区患者用药依从性为66.1%(517/782),好于经济发达地区的59.3%(248/418),40岁人群患者用药依从性为71.6%(96/134),好于其他年龄组的62.8%(669/1 066);慢性病患者用药依从性的影响因素主要包括患者用药偏好、基层医疗机构的药物供应与用药指导等。结论当前应在基本药物制度顶层设计优化、慢性病患者用药偏好矫正与基层医疗机构用药指导方面加大建设力度。     

北京市房山区老年慢性病患者用药依从性及影响因素分析

目的 探讨老年慢性病患者用药依从性及影响因素，为提高老年慢性病患者治疗效果提供依据。方法 2022年2-5月，采用分层整群随机抽样方法对居住在北京市房山区的老年慢性病患者进行用药依从性调查，分析老年慢性病患者的一般情况、患病情况、用药情况对用药依从性的影响。结果 1 014名老年慢性病患者中，607人（59.86%）用药依从性好。其中，60～69岁、初中及以上学历、家庭人均月收入≥1 000元/月、跌倒次数为0次、无视力障碍、无听力障碍的老年慢性病患者用药依从性好的比例分别高于年龄≥70岁、小学及文盲、家庭人均月收入<1 000元/月、近1年内跌倒次数≥1次、有视力障碍、有听力障碍的老年慢性病患者（P均<0.001）；多因素logistic回归分析显示，年龄（OR=0.030,95%CI:0.019～0.047）、学历（OR=7.663,95%CI:5.032～11.670）、家庭人均月收入（OR=1.610,95%CI:1.076～2.407）、跌倒次数（OR=0.281,95%CI:0.163～0.485）是老年慢性病患者用药依从性的影响因素。结论 北京市房山区老年慢性...     

慢性病患者服药依从性的研究分析

目的探讨慢性病患者服药依从性。方法选取84例老年慢性病患者为研究对象,对服药依从性进行研究分析。结果 49例患者服药依从性存在问题,所占比例58.3%。结论为了提高慢性病患者服药依从性,希望通过短信这一方便、快捷的平台来提醒慢性病患者按时服药,解决了许多患者特别是老年患者容易忘记或对用药方法不明的情况,逐渐提高患者的用药依从性。     

基于互联网平台的健康教育在接受糖皮质激素雾化吸入哮喘患儿中的应用

目的探讨基于互联网平台的健康教育在接受糖皮质激素雾化吸入哮喘患儿中的应用效果。方法选取2021年3月至2022年3月于我院接受糖皮质激素雾化吸入的80例哮喘患儿,按照抽签法分为观察组与对照组。对照组采用常规护理,观察组采用基于互联网平台的健康教育。比较两组的用药依从性、家庭疾病管理能力及临床症状。结果干预1个月、3个月、6个月,观察组用药依从性评分高于对照组(P<0.05)。观察组FMM各项评分高于对照组(P<0.05)。干预3个月、6个月后,观察组临床症状评分低于对照组(P<0.05)。结论基于互联网平台的健康教育可提高接受糖皮质激素雾化吸入哮喘患儿的用药依从性,改善其临床症状,增强家属的家庭疾病管理能力。     

长期糖皮质激素治疗对慢性病患儿自我意识和抑郁情绪的影响

目的探讨长期糖皮质激素治疗对慢性病患儿自我意识和抑郁情绪的影响。方法采用便利抽样法选取2018年1月至12月本院收治的长期接受糖皮质激素治疗的慢性病患儿276例,收集患儿的一般资料、慢性病相关资料、糖皮质激素使用情况;使用Piers-Harris儿童自我意识量表(PHCSS)评估患儿自我意识状况,儿童抑郁障碍自评量表(DSRSC)评估患儿抑郁情绪。结果 276例长期接受糖皮质激素治疗的慢性病患儿中自我意识水平较低58例(21.01%)。长期接受糖皮质激素治疗的慢性病患儿自我意识量表总得分明显低于常模,差异有统计学意义(P0.05);其中行为、合群、焦虑、躯体外貌分量表得分明显低于常模,差异均有统计学意义(均P0.05)。276例长期接受糖皮质激素治疗的慢性病患儿中存在抑郁障碍47例(17.03%);抑郁自评量表得分(9.81±2.75)分,明显高于常模(8.95±2.30)分,差异有统计学意义(P0.05)。多元逐步回归分析结果显示,性别、年龄、病程、住院次数、激素服用剂量、累计服药时间、激素副作用是患儿自我意识的独立影响因素(均P0.05);性别、年龄、住院次数、激素服用剂量、累计服药时间、激素副作用是患儿抑郁障碍的独立影响因素(均P0.05)。结论长期糖皮质激素治疗造成慢性病患儿的自我意识偏低,易出现抑郁情绪,应针对相关影响因素进行干预,促进慢性病患儿心理健康发展。     

离退休老年人对慢性病管理的依从性影响因素调查研究

目的了解离退休老年人对慢性非传染性疾病(慢性病)管理的依从性现状,为提高老年人慢性病管理依从性和老年人生活质量提供参考。方法在2015年9月通过简单随机抽样的方法在湖州老年大学选取45位老年慢性病患者,且患有高血压、高血脂、糖尿病三种慢性病中的一种或多种,从服药、复诊等方面设计慢性病管理的心理依从性调查问卷进行现况性调查。结果离退休老年人对慢性病管理的依从性整体状况较好,68.3%和63.4%的老年人在病情改善或变坏时选择询问医生再决定是否停药;一半以上的老年人都选择不会因为药太贵、用药方案太复杂而自行调药;87.8%的老年人都会按照医嘱进行复诊。结论离退休老年人对慢性病管理的依从性总体情况较好,但依从的健康信念及行为仍有待提高。要想进一步提高老年人慢性病管理依从性,需要采用科学有效、策略综合的方法,才能更好地提高老年人慢性病管理的心理依从性。     

Pediatric adherence: perspectives of mothers of children with HIV

This study approached pediatric adherence practices from the perspective of mothers of children with HIV in the USA. The study aimed to articulate what is involved in the daily life experience of giving or supervising a child's HIV medication (i.e., adherence practices) in order to clarify, in more dynamic terms than is often found in adherence research, what promotes or impedes adherence. A team-based qualitative analytic approach was used to analyze the narrative responses of 71 maternal caregivers of children with HIV to interview questions regarding the activities and stresses of caring for a child with HIV. Four themes of dealing with medication on a daily basis that impacted mothers' adherence practices emerged from the analysis: (1) Mothers' attitudes and feelings related to adherence practices. (2) The impact of the medications on adherence practices. (3) Interactions of mothers and children related to adherence practices. (4) Developmental issues and responsibility for medication adherence. These themes, taken together, demonstrate the contextual and longitudinal factors that impact adherence and illustrate the complexity of influences on adherence practices. We found that adherence practices were impacted in a positive way by mothers' commitment to adherence, and in a negative way by feelings of stigma and guilt, by the effects of bereavement on children and by children adopting their mothers' attitudes about medications. The interactive process of giving medication was shaped by children's behavior, mothers' developmental expectations for children, and, for mothers with HIV, their adherence for themselves. We found that pediatric adherence often came at a cost to the caregiving mother's well-being.     

Adults with cystic fibrosis: spiritual coping with lifelong disease

Abstract

Cystic fibrosis (CF) is a chronic life-shortening disease requiring significant coping. Spiritual belief relates to treatment behaviors. Little is known about spirituality’s role in adults diagnosed as children, nor how it compares with adults diagnosed as adults. Adults over 18?years, diagnosed as children completed a questionnaire; some were randomized to also participate in an interview or daily phone diary to measure adherence. Qualitative analyses of 25 adults are presented. Participants reframed their disease as part of a Divine Plan, in which Divine assistance was conditional upon adherence. Linear regression models of spiritual constructs on airway clearance, nebulized medication, and exercise are presented. Adults diagnosed as children related spirituality to CF in ways both consistent and different from adults diagnosed as adults. Spiritual beliefs were related to adherence determinants and intentions. Increased understanding of the relationship between spirituality and health behaviors is important to providing person-centered care.     

An experiment using hypothetical patient scenarios in healthy subjects to evaluate the treatment satisfaction and medication adherence intention relationship

Background

Treatment beliefs and illness consequence have been shown to impact medication adherence in patients with years of asthma experience. These relationships are unknown in patients with early experience.

Objective

The purpose was to test the relationship between illness consequence, treatment beliefs, treatment satisfaction and medication adherence intentions in healthy subjects exposed to an asthma scenario.

Methods

A 2×2×2 factorial design experiment was conducted in 91 healthy University student subjects. Each student was randomized to receive one scenario with varying levels of illness consequence (high/low), treatment concerns (high/low) and treatment necessity (high/low). After reading the scenarios the students responded to questions about treatment satisfaction and likelihood of using the medication as directed by the physician. A multiple regression model was used to test the impact of factors on treatment satisfaction and medication adherence at the 0.05 level of significance.

Results

Treatment satisfaction was significantly predicted by treatment necessity with a moderating effect by illness consequence. Medication adherence intentions were significantly predicted by treatment satisfaction.

Conclusion

Patients with early diagnosis of asthma are likely to form treatment satisfaction as a result of illness consequence and treatment necessity. Patients'' perceptions of illness consequence are likely to influence (moderate) the impact of treatment necessity on treatment satisfaction; and their intentions to take medication as directed are likely to be influenced by treatment satisfaction rather than treatment beliefs or illness consequence early in the patient illness experience. These results are from an experiment that should be tested in a patient population.     

Greater adherence to diabetes drugs is linked to less hospital use and could save nearly $5 billion annually

Improving adherence to medication offers the possibility of both reducing costs and improving care for patients with chronic illness. We examined a national sample of diabetes patients from 2005 to 2008 and found that improved adherence to diabetes medications was associated with 13?percent lower odds of subsequent hospitalizations or emergency department visits. Similarly, losing adherence was associated with 15?percent higher odds of these outcomes. Based on these and other effects, we project that improved adherence to diabetes medication could avert 699,000 emergency department visits and 341,000 hospitalizations annually, for a saving of $4.7?billion. Eliminating the loss of adherence (which occurred in one out of every four patients in our sample) would lead to another $3.6?billion in savings, for a combined potential savings of $8.3?billion. These benefits were particularly pronounced among poor and minority patients. Our analysis suggests that improved adherence among patients with diabetes should be a key goal for the health care system and policy makers. Strategies might include reducing copayments for certain medications or providing feedback about adherence to patients and providers through electronic health records.     

Beliefs related to adherence to oral antidiabetic treatment according to the Theory of Planned Behavior

OBJECTIVE:

to identify salient behavioral, normative, control and self-efficacy beliefs related to the behavior of adherence to oral antidiabetic agents, using the Theory of Planned Behavior.

METHOD:

cross-sectional, exploratory study with 17 diabetic patients in chronic use of oral antidiabetic medication and in outpatient follow-up. Individual interviews were recorded, transcribed and content-analyzed using pre-established categories.

RESULTS:

behavioral beliefs concerning advantages and disadvantages of adhering to medication emerged, such as the possibility of avoiding complications from diabetes, preventing or delaying the use of insulin, and a perception of side effects. The children of patients and physicians are seen as important social references who influence medication adherence. The factors that facilitate adherence include access to free-of-cost medication and taking medications associated with temporal markers. On the other hand, a complex therapeutic regimen was considered a factor that hinders adherence. Understanding how to use medication and forgetfulness impact the perception of patients regarding their ability to adhere to oral antidiabetic agents.

CONCLUSION:

medication adherence is a complex behavior permeated by behavioral, normative, control and self-efficacy beliefs that should be taken into account when assessing determinants of behavior.     

In chronic disease, nationwide data show poor adherence by patients to medication and by physicians to guidelines

PURPOSE: It is widely acknowledged in small studies that provider variation from evidence-based care guidelines and patient medication nonadherence lead to less than optimal health outcomes, increasing costs, and higher utilization. The research presented here aims to determine the prevalence of patient adherence to a medication regimen and provider adherence to guidelines for a variety of chronic conditions, using nationally representative data. DESIGN: A retrospective analysis of administrative claims data from a large national insurer was conducted. METHODOLOGY: The study examined multiple quality indicators exemplifying evidence-based medicine and medication adherence for several chronic conditions. Medication possession ratio (MPR) determined patient adherence. Using EBM Connect software created by Ingenix, we measured adherence to guidelines by applying a series of clinical rules and algorithms. PRINCIPAL FINDINGS: Adherence to the evidence-based practice guidelines examined in this study averaged approximately 59 percent, while patient medication nonadherence rates for all the conditions studied averaged 26.2 percent, with a range of 11 percent to 42 percent. Physician adherence to guidelines was highest in the prescribing of inhaled corticosteroids for persistent asthma. Ironically, medication adherence rates for inhaled corticosteroids were the worst identified. The best medication adherence rate was observed in patients with hypertension. CONCLUSION: Like earlier studies, this analysis finds that poor adherence is common across the nation and across common chronic conditions.